How long have we heard that telemedicine is the wave of the future? For at least a decade, the biggest impediments to the general acceptance of telemedicine have been widespread consumer acceptance, widespread usage of technological platforms, privacy concerns, and payment rate disincentives.
Fear can be an amazing motivator. During the age of COVID, the last place most people wanted to be was at the doctor’s office with sick people. Suddenly, demand for telemedicine soared, and amazingly, people using telemedicine preferred it to office visits. The convenience of avoiding the physician’s office, the assurance of not being exposed to other illnesses, and the end of the “two-hour wait for a ten-minute appointment” changed consumer sentiment.
Contemporaneously with the rise in telemedicine, everyone began using Zoom—for work, to connect with family, for happy hour, even for worship services and Easter dinner. The platform, which works well for telemedicine, gained widespread acceptance overnight, sweeping away the technology impediment.
In the late 1990s, privacy concerns in healthcare became ascendant, assuming inordinate importance, reducing convenience, and increasing the cost of healthcare. With the increased use and convenience of telemedicine, its cost savings in reduced time away from work, and its potential to provide services to more people more efficiently, privacy concerns have started to come into balance. With HIPAA-compliant technology, consumers now see telemedicine as worth the risk.
The final impediment to widespread use is the disparate payment rates by Medicare and other payors between in-office and telemedicine services. Already there have been statements from CMS officials and others about the possible equalization of payment rates. As consumers demand telemedicine, private insurers will want to incentivize physicians to offer telemedicine services. We expect rates to rise, and with the impediments to implementation falling away, we expect to see widespread use of telemedicine going forward.
Perhaps the biggest impact of telemedicine will be in psychology and psychiatry. COVID-driven rule changes permitting tele-prescription of psychiatric drugs permit physicians to see psychiatric patients remotely. Being able to treat patients regardless of their location should be a great benefit to patient care. We expect to see restrictions loosened on physicians treating across state lines. For several years, office sharing among mental health professionals has been on the rise. If visits following the initial office appointment can be done remotely, then office sharing is likely to become the norm, saving significant overhead in the mental health system.
We expect other impacts on physician office space. Just as electronic medical records eliminated the need for storage, increased telemedicine exams will lead to fewer exams in the office and fewer exam rooms needed. We anticipate a rise in work-from-home situations allowing for staff office sharing. Offices will likely have telemedicine suites where providers can comfortably provide remote services. Opposite trends may be the desire for “sick” and “well” and more spread-out waiting rooms, but allowing patients to remain in their vehicles until they receive a text to enter for their appointments could offset this arrangement. It’s likely that physicians will be able to reduce office space, thereby reducing overhead.
Redefining “Necessary” and “Essential”
COVID has provided new definitions for “essential” and “necessary.” The 2008 financial crash had disproportionate impacts on practices like cosmetic dentistry and cosmetic surgery. As people emerge from the COVID financial crisis, there will likely be a reticence to engage in expensive, non-essential healthcare services. As more patients now have high-deductible healthcare plans, we can expect to see people question out-of-pocket costs for services that were not deemed “necessary” during COVID. Coupled with this is a 9/11-type reassessment by people about what is important. Physicians should be prepared: a return to “normal” may take longer than anticipated.
Limited Hospital Stays
Fear of hospital-borne infection is palpably high. The primary demand of patients post-COVID will be to be kept out of hospitals, leading to an increase in visits to walk-in clinics and an increase in outpatient surgery. During COVID, hospitals have been quick to discharge patients to home care, where recoveries are generally improved. Expect this trend to continue, as patients demand to be discharged from hospitals as fast as possible.
Decreased Confidence in Senior Living
Repeated bad news from senior living facilities, where the spread has been significant and the death rate higher for COVID, will lower consumer confidence in those facilities, even those with good COVID records. Families will feel increasingly guilty about placing seniors in facilities, especially in light of the COVID-imposed visitation restrictions. Families will look to alternatives, including keeping senior relatives at home to reduce the risk of admission to a senior living facility.
Increase in Home Health
The coming decrease in hospital stays, coupled with reluctance to utilize senior living facilities, should increase home health visits. Increased home health visits should also be a side effect of telemedicine, as blood pressure checks and blood draws are increasingly likely to be done in the home. We expect the competition for quality home health nurses and aides will increase. We also anticipate an increase in the rise of a newer trend in senior living: adult daycare.
Navigating the Future
These trends are but a few we anticipate as we emerge from the COVID crisis. We hope we have helped you think about what your future practice may look like and given you some ideas to prepare you to face the challenges ahead. Our Business Reemergence Solutions group is available to assist with issues that arise.